Dry Eye Syndrome
Original article contributed by:
Daniel E. Bustos, MD, MS, Alpa S. Patel, M.D.
Alpa S. Patel, M.D., Daniel E. Bustos, MD, MS and Sadiqa K Stelzner, MD, FACS
Assigned status Up to Date by Sadiqa Stelzner on December 12, 2014.
Dry Eye Syndromeis a pervasive issue in society. With appropriate evaluation and treatment,people can be quite comfortable.
· 1 Dry Eye Syndrome
o 1.1 Overview
o 1.2 Causes
o 1.3 Evaluation
· 2 Management
o 2.1 Prognosis / Follow up
Dry Eye Syndrome[edit source]
Overview [edit source]
Dry eye syndromeis one of the most common problems affecting the general population and cancause problems that range in severity from mildly irritating to debilitating.Dry eye syndrome is a general term that describes the state of the front of theeye in response to a breakdown in the natural layer of tears that coats thefront of the eye, called the tear film. Normally, this layer of tears is astable, homogenous layer that not only provides the cornea and conjunctiva a healthybuffer from damage were it constantly exposed to the air, but this interfacebetween the tear film and the air is also responsible for a significant amountof the focusing power of the eye. When the tear film becomes unhealthy, itbreaks down in different places on the cornea and conjunctiva, leading not onlyto symptoms of irritation, but also to unstable and intermittently changingvision.
While there arenumerous different symptoms one can experience, prominent amongst thesesymptoms is tearing; naturally, a patient may wonder why their eye can be “dry”despite producing plenty of tears. This is because the unhealthy tear film andthe irritation that comes from it stimulates the brain to produce a wave orreflex of tears to help counteract the irritation. However, this reflex tearingis simply insufficient to correct the overall problem. For this reason, dry eyesyndrome could more appropriately be termed “Tear FilmDysfunction.” Other symptoms of dry eye syndrome or tear filmdysfunction include:
· sandy or gritty feeling
· Scratchy or foreign-body sensation
· Frequent blinking
· Mattering or caking of the eyelashes (usually worse uponwaking)
· Blurry or fluctuating vision (made worse when reading,computer, watching television, driving, or playing video games)
· Eye pain and/or headache
· heavey eye lids
· eye fatigue
· Decreased hormones associated with aging
· Thyroid eye conditions
· Eyelid inflammation (blepharitis)
· Medication/supplement use, including psychiatricmedicines, OTC cold medicines, anti-histamines, beta-blockers, pain relievers,sleeping pills, diuretics, Hormones replacement, and oral contraceptives
· Sjogren's syndrome (dry mucus membranes throughout body)
· Other autoimmune disorders including Lupus and/orRheumatoid Arthritis
· Chemical splashes / injuries to the eyes
· Eye surgery
· Infrequent blinking, associated with staring at computeror video screens,and Parkinson's
· Environmental (dusty, windy, hot/dry)
· Contact lens use
· Neurologic conditions, including stroke, Bell's palsy,Parkinson's, trigeminal nerve problem,
· Exposure keratitis, in which the eyelids do not closecompletely during sleep ie lagophthalmos
· Post refractive surgery (LASIK or PRK), it may generallylast three to six months,or longer
· Inflammatory eye conditions, including Herpes virusinfections and uveitis / iritis
· Vitamin A deficiency (rare in US)
Sometimes thereare obvious signs of dry eye syndrome / tear film dysfunction that you,acquaintances or even your primary care doctor may notice that may prompt youto seek treatment. However, if you have any symptoms indicative of this butthere don’t seem to be obvious signs of it, that doesn’t mean you don’t sufferfrom it. In fact, most people with dry eye syndrome / tear film dysfunctionhave signs of it which are not even obvious on a general, screening eye exam.For this reason, if dry eye syndrome / tear film dysfunction is suspected byyou or your primary care doctor, a thorough, targeted evaluation for dry eyesyndrome by your eye MD doctor is frequently necessary to uncover thediagnosis. Depending on your particular constellation of signs, symptoms,history and comorbidities, your doctor may order tests ranging from Shirmertear test to blood tests to check for systemic disease.
An individualwith dry eye syndrome / tear film dysfunction may, in fact, have more than onecause acting simultaneously to produce the symptoms. This is actually the casefor many persons who suffer from dry eye syndrome. For this reason, manypersons who undergo casual evaluations and/or treatment attempts of dry eyesyndrome without investigating for and treating all the possible causes can endup becoming frustrated, have persistent symptoms that can worsen, and may jumpfrom doctor to doctor to seek relief.
Depending on thecauses, there are numerous treatments for dry eye syndrome / tear filmdysfunction, but the more common treatment modalities include:
· Artificial tears (preferably ones without aredness-reliever component in them)
· Longer acting agents such as artificial tear gel andointments and lacrisert
· Tear conserving interventions such as punctal plugs
· Warm compresses
· Eyelash scrubs
· Prescription medicines to encourage tear-production suchas Restasis
· Topical ophthalmic steroids are helpful in controllingthe inflammatory aspect of the disease.
· Oral flaxseed oil or fish oil supplements 2000mg/day hasalso been found to be useful in alleviating symptoms and decreasing thefrequency of topical agents.
Prognosis / Follow up[edit source]
Most people withdry eye syndrome who keep up with their regimen as prescribed by their eyedoctor are able to have their symptoms controlled, allowing them to functioneither symptom-free or with minimal difficulty. Because of the nature of thecauses of dry eye syndrome, most people do not get “cured” of their problem,but with regular maintenance can function as though they are cured. However,even the patient who is well-controlled on maintenance therapy can havebreak-through episodes and require a visit to their eye doctor, in addition toregularly scheduled visits (which is usually once to twice per year).
To learn moreabout dry eyes, please log on to http://www.geteyesmart.org/eyesmart/diseases/dry-eye.cfm